Co-occurring Disorders Treatment
Scenario:
A 45 year old African American female was admitted to a detoxification facility with reports that she was consuming three pints of whiskey daily for the past three years. The patient also reports she last drank alcohol approximately “ten hours ago.” Answer the following questions:
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Co-occurring Disorders Treatment
Based on this scenario, respond to the following prompts:
- Explain the etiology of Alcohol Addiction.
- According to the DSM V-TR, what is the criteria for this condition? What screening tools are available for measuring Alcohol Withdrawal Syndrome?
- What treatment options will you offer this patient and why? (Provide pharmacological interventions, including nursing interventions, as well as cultural considerations for African American populations with this condition).
- If the patient later reports a history of promiscuity and sexually-transmitted infections, impulsivity, aggression, and irritability, how does this impact the patient’s treatment plan? Explain the concept of co-occurring disorder and its relevance to this case study.
Etiology, Diagnosis, and Screening of Alcohol Addiction
Alcohol addiction, or alcohol use disorder (AUD), results from chronic alcohol consumption that alters brain function. It affects dopamine and GABA receptors, reinforcing dependency. Genetics, environmental factors, and stress also contribute. According to the DSM-5-TR, AUD is diagnosed when at least two of eleven criteria are met within 12 months. These include increased tolerance, withdrawal symptoms, failed attempts to stop, and continued use despite problems. In this case, the patient’s prolonged use and inability to quit meet several criteria.
Screening tools such as the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) are used to assess withdrawal severity. This tool helps guide clinical decisions and predict complications such as seizures or delirium tremens. Early identification of withdrawal symptoms ensures timely pharmacological intervention. Nurses should monitor blood pressure, heart rate, and neurological status frequently to ensure safety.
Treatment Options and Co-occurring Disorders
The treatment plan should include benzodiazepines to manage withdrawal symptoms and prevent seizures. Thiamine and multivitamins are essential to prevent Wernicke’s encephalopathy. Nursing interventions include continuous monitoring, supportive care, and patient education. For African American patients, cultural considerations must be addressed. These include respect for family involvement, spiritual beliefs, and historical mistrust of healthcare systems. Community-based support and culturally competent counseling enhance engagement.
If the patient later reveals impulsivity, aggression, and risky sexual behavior, this may suggest a co-occurring mental health disorder. Co-occurring disorders involve the presence of both a substance use disorder and a mental illness. These require integrated treatment strategies addressing both conditions. Cognitive behavioral therapy (CBT) and medication management may be necessary. The presence of sexually transmitted infections (STIs) would require referral for appropriate medical care and additional counseling.
